MALARIA

dr. Nenci Siagian Sp.PD

RSUD Waibakul Sumba Tengah
5 Agustus 2022
 Outline
 About the Malaria
 Case Management
 Case Discussion
 Conclusion
 About the Malaria
• Malaria continues to cause unacceptably high levels of disease and
death  there were an estimated 229 000 cases and 409 000 deaths
globally in 2019.
• The Global technical strategy for malaria 2016 - 2030 [4]  ensure access
to malaria prevention, diagnosis and treatment as part of universal
health coverage
• Malaria is preventable and treatable
• The goal  malaria Elimination in 2030
 About the Malaria
• Malaria is caused by the infection of red blood cells with protozoan parasites
of the genus Plasmodium.

• Malaria is transmitted to people through the bites of infected female

Anopheles mosquitoes.

• Five species of Plasmodium (P. falciparum, P. vivax, P. malariae and P. ovale)

and P. knowlesi

• P. knowlesi is species of Plasmodium that primarily infects non-human

primates) is increasingly being reported in humans (South-East Asia, the
Western Pacific regions, particular on the island of Borneo)
 About the Malaria
• The intensity of transmission depends on the vector, the human host and
the environment.

• The survival and longevity of female mosquitoes is of critical importance in

malaria transmission and it depends on intrinsic, genetic factors and
environmental factors (temperature & humidity)

• Malaria parasite generally requires a period of 7–10 days to develop inside

the mosquito into a form that is infective to humans.

• The strong human biting habit of the African vector species is one of the
reasons why approximately 90% of the world’s malaria cases occur in
Africa.
 About the Malaria
• Transmission intensity is usually assessed as the incidence of cases or the
prevalence of infection (API = number of new parasitologically confirmed
malaria cases per 1000 population per year).

• The following categories of transmission intensity are :

1. High transmission  API ≥ 450 and a P. falciparum prevalence rate of ≥35%.
2. Moderate transmission API 250–450 and a prevalence of P. falciparum/P.
vivax malaria of 10–35%.
3. Low transmission  API 100–250 and a prevalence of P. falciparum/P. vivax
of 1–10%.
4. Very low transmission  API < 100 and a prevalence of P. falciparum/P. vivax
malaria > 0 but < 1%
 Case Management
• Malaria case management  early diagnosis and prompt effective
treatment, remains a vital component of malaria control and elimination
strategies.

• The classic types of the malaria fever are : cold stage, hot stage and
sweating stage

• If the infection left untreated the fever in P.vivax and P.ovale regularizes
to a 2 days, P. malariae on 4 days and P. falciparum remain erratic for
longer (malaria life cycle)

• DD  Dengue, Typhoid, Leptospirosis and Chikungunya

 Case Management
• Early diagnosis based on the clinical manifestation and parasitological
founding (RDT, Microscopic, PCR, Immunofloroscence)

• Thick smears are more sensitive than thin smear but less specific

• The treatment of malaria is classified into two groups  uncomplicated

malaria and complicated malaria.

• The treatment of malaria always based on rational use of antimalarial

agent, combination therapy and appropriate weight-based dosing.
 RELAPS
3-6 Weeks or longer

RECRUDESCENT
 Case
Management
Profilaksis Malaria
 Case Discussion
• Laki-laki, 28 th
• Demam tinggi 1 hari, sakit kepala, nyeri otot, keluhan
lagi tidak ada, makan/minum cukup
 Conclusion
• Malaria is infectious disease that caused by plasmodium
and may be fatal
• The diagnosis of Malaria is confirmed by RDT,
Microscopic or both
• Malaria treatment for uncomplicated case use ACT
agent such as DHP at least for 3 days and primaquine
(based on the type of plasmodium)
• Malaria treatment for severe malaria use aretesunat
injection
• Second line treatment for malaria is Quinine
 References
• Buku Saku Tata laksana Kasus Malaria Kemenkes RI
tahun 2020
• KMK RI No. HK.01.07/MENKES/556/2019 Tentang
Pedoman Nasional Pelayanan Kedokteran Tata laksana
Malaria
• WHO guideline for Malaria 2021
Terima Kasih